Young, low-income mothers' social relationships and involvement in doula home visiting services

Relationships with family, partners and friends may shape mothers' involvement with home visiting services, and discrepancies exist in the literature regarding whether supportive social relationships are associated with more service involvement or less involvement. Mothers with more support may be more involved in services because their history of support may enable them to build trusting working alliances with service providers (relation-ships-beget-relationships). Alternatively, mothers with less support may be more involved because they may be in greater needs of services (relationship-compensation). This study examined patterns of mothers' social relationships and associations with the mothers' working alliances (agreement on tasks and goals, bonding) and use of home-visiting services provided by doulas in pregnancy and early postpartum. Data were collected from young, low-income mothers (N = 147; mean age = 18.5 years old; 49.7% African American, 41.5% Latina, and 8.8% European American/Other) who participated in doula-enhanced-home-visiting programs and from pro-gram administrative systems. Doulas provided home visits starting in pregnancy through six weeks postpartum and provided support during childbirth at the hospital. Eight indicators of mothers' relationships with their current parent figure (usually their mother; PF), the father of their baby (FOB), and general social network were measured. Latent profile analysis identified four relationship profiles: strong support from PF, FOB and others (27%), moderate support overall (40%), moderate support from FOB but alienation from PF (15%), and moderate support from PF but alienation from FOB (18%). Mothers with strong social relationships reported higher agreement with their doula on tasks/goals both during pregnancy and postpartum; mothers with challenging relationships with their parent figure had fewer pregnancy home visits and were less likely to have doula hospital attendance but had similar frequency of postnatal home visits as other classes. Relationship profiles were not associated with bonding with the doula, postnatal service frequency, or early service discontinuation. This study primarily provided support to the relationships-beget-relationships mechanism, but also suggested that mothers with a challenging history with their parent figure may become more involved in services after the birth of their baby. A deep understanding of young mothers' relationship history can help home visitors provide equitable and individualized services to promote family and child wellbeing, especially for mothers with challenging histories with their caregiver.